IC 052 Guide to Harris County Academy of General Practice Records

The Harris County Association of General Practice is a component branch of the American Academy of General Practice and the Texas Chapter of the American Academy of General Practice. Through the diligent efforts of Dr. Lyman C. Blair and others a charter was issued on July 23rd, 1948, thereby establishing the Harris County Chapter. See more at https://archives.library.tmc.edu/ic-052

Design and intermediate results of the Lower Extremity Arterial Disease Event Reduction (LEADER)* trial of bezafibrate in men with lower extremity arterial disease [ISRCTN41194621]

BACKGROUND: Raised levels of both triglycerides and fibrinogen, each of which are reduced by bezafibrate, may contribute to lower extremity arterial disease (LEAD). This condition is characterized by a particularly high incidence of coronary heart disease (CHD) and stroke, but is little studied thus far in randomised controlled trials. METHOD: Patients were recruited through 85 practices in the British Medical Research Council General Practice Research Framework and through nine hospital vascular clinics. The treatment regimen, which is double-blind and placebo-controlled, is bezafibrate 400 mg/day. The 1568 patients recruited represent 86% of those eligible at screening. RESULTS: None of the anticipated side effects (mainly gastrointestinal) differed between the two groups. Nearly 80% of the total person-years accrued at 3 years were spent on trial treatment. Bezafibrate significantly reduced total cholesterol by approximately 8.0% and low-density lipoprotein (LDL)-cholesterol by approximately 9.0%, and increased high-density lipoprotein (HDL)-cholesterol by approximately 11.0% initially, falling to about 6.0% at 3 years. Triglycerides were significantly reduced by about 23.0% and fibrinogen by about 14.0%. Plasma creatinine rose by approximately 11% in those on active treatment. All of these effects were highly significant (P < 0.0001). Bezafibrate had no effect on the level of C-reactive protein (CRP). CONCLUSION: The trial recruited an unusually high proportion of eligible patients, ensuring the general applicability of its results. The fibrinogen-lowering and lipid-modifying effects of bezafibrate were confirmed. Although bezafibrate lowers fibrinogen, it has no effect on CRP; this suggests that the reduction in fibrinogen is due to an effect on its metabolism rather than suppression of an inflammatory response

Validation instruments for health promotion in the community pharmacy setting

The developments during the past fifty years have resulted in a complete shift in the role of the community pharmacist from that of mainly compounding of medicines to becoming an advisor on health-related issues (Schaefer, 1998). This shift resulted in highlighting the intervention of the pharmacist as the initial contact point for the provision of primary health care. An initiative undertaken in the United Kingdom in 1995, 'Pharmacy in a New Age', identified health promotion as one of the areas that community pharmacists should focus more on (Royal Pharmaceutical Society of Great Britain, 1996). In this day and age of cost containment. evidence-based practice is required to confirm the provision of professional services, including the provision of health promotion (Rupp, 1997). This prompted the development of the Validation Method for Community Pharmacy, which is a process carried out to confirm the effectiveness of the pharmacist in the community setting (Azzopardi, 2000).peer-reviewe

Training, status and migration of general practitioners / family physicians within Europe

The survey intended to explore and identify the training background and status of general practitioners/ family physicians (GPs) in member countries within EURACT (European Academy of Teachers in General Practice/Family Medicine), and to gain an overview of processes involved when GP-trained doctors migrate to work in another member country. A questionnaire, with closed and open-ended questions, was sent to representatives of all 39 EURACT-member countries in 2009. The main outcome measures were the training background and status of GPs in public/private settings in each country and the requirements of additional training and testing when migrating to another country. Forty-one completed questionnaires were received from 31 (79%) of the EURACT countries. The data indicate that specialist training for General Practice/ Family Medicine (GP/FM) is well established throughout and generally required for appointment to public career posts. The data also indicate that European Uniontrained GPs can move freely to most countries with usually no tests of medical knowledge or language proficiency. Orientation to the healthcare system in the destination country is usually not provided. work in public/private GP/FM posts in many European countries, although new appointments to public posts RESEARCH ARTICLE Training, status and migration of General Practitioners/Family Physicians within Europe in nearly all countries require specialist GP training. It was not possible to identify a uniform or agreed approach applied by employing agencies to confirm the medical competence and language skills of migrant doctors and to provide them with orientation to healthcare systems. In the high-context dependent discipline of GP/FM this is of concern.peer-reviewe

Adapting developing country epidemiological assessment techniques to improve the quality of health needs assessments in developed countries

BACKGROUND: We were commissioned to carry out three health assessments in urban areas of Dublin in Ireland. We required an epidemiologically robust method that could collect data rapidly and inexpensively. We were dealing with inadequate health information systems, weak planning data and a history of inadequate recipient involvement in health service planning. These problems had also been identified by researchers carrying out health assessments in developing countries. This paper reports our experience of adapting a cluster survey model originally developed by international organisations to assess community health needs and service coverage in developing countries and applying our adapted model to three urban areas in Dublin, Ireland METHODS: We adapted the model to control for socio-economic heterogeneity, to take account of the inadequate population list, to ensure a representative sample and to account for a higher prevalence of degenerative and chronic diseases. We employed formal as well as informal communication methods and adjusted data collection times to maximise participation. RESULTS: The model we adapted had the capacity to ascertain both health needs and health care delivery needs. The community participated throughout the process and members were trained and employed as data collectors. The assessments have been used by local health boards and non-governmental agencies to plan and deliver better or additional services. CONCLUSION: We were able to carry out high quality health needs assessments in urban areas by adapting and applying a developing country health assessment method. Issues arose relating to health needs assessment as part of the planning cycle and the role of participants in the process

Recognition of physical and psychological symptoms: no influence of GP demographic factors

AIM: To describe the relationship between general practitioner demographic factors and the recognition of psychological and physical symptoms in consultation. METHODS: A survey of a random sample of 70 GPs and their patients (n=3414) from the lower North Island of New Zealand. RESULTS: No relationship was found between GP personal and practice demographic characteristics and GP identification of psychological and physical symptoms. Patients were more likely not to present psychological symptoms (62%) than not present physical symptoms (5%) in consultation. Thirteen percent of GPs wanted more formal psychiatric training, 45% wanted more contact time in consultation, and 72% thought that cost was a barrier to patients attending. No significant relationship was found between these factors and GP detection of significant psychological symptoms in consultation. DISCUSSION: Personal and practice demographics of GPs may not predict their ability to detect physical and psychological symptoms. More research is needed to explore these findings which contradict previous work

Patients' use and views of real-time feedback technology in general practice.

BACKGROUND: There is growing interest in real-time feedback (RTF), which involves collecting and summarizing information about patient experience at the point of care with the aim of informing service improvement. OBJECTIVE: To investigate the feasibility and acceptability of RTF in UK general practice. DESIGN: Exploratory randomized trial. SETTING/PARTICIPANTS: Ten general practices in south-west England and Cambridgeshire. All patients attending surgeries were eligible to provide RTF. INTERVENTION: Touch screens were installed in waiting areas for 12 weeks with practice staff responsible for encouraging patients to provide RTF. All practices received fortnightly feedback summaries. Four teams attended a facilitated reflection session. OUTCOMES: RTF 'response rates' among consulting patients were estimated, and the representativeness of touch screen users were assessed. The frequency of staff-patient interactions about RTF (direct observation) and patient views of RTF (exit survey) were summarized. Associated costs were collated. RESULTS: About 2.5% consulting patients provided RTF (range 0.7-8.0% across practices), representing a mean of 194 responses per practice. Patients aged above 65 were under-represented among touch screen users. Receptionists rarely encouraged RTF but, when this did occur, 60% patients participated. Patients were largely positive about RTF but identified some barriers. Costs per practice for the twelve-week period ranged from £1125 (unfacilitated team-level feedback) to £1887 (facilitated team ± practitioner-level feedback). The main cost was the provision of touch screens. CONCLUSIONS: Response rates for RTF were lower than those of other survey modes, although the numbers of patients providing feedback to each practice were comparable to those achieved in the English national GP patient survey. More patients might engage with RTF if the opportunity were consistently highlighted to them.National Institute for Health Research (NIHR) Programme. Grant Number: RP‐PG‐0608‐10050This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Wiley